Bilateral Microtia-Atresia

Integration of Outer-and Middle-Ear Surgeries

or
optimal function and aesthetics in bilateralmicrotia,
one must plan to integrate surgical procedures so that one does not compromise
the other (see Fig. 24). In these cases, the auricular construction
should precede the middle-ear surgery
because, once an attempt is made to "open" the ear, chances of
obtaining a satisfactory auricular repair are severely compromised because
the invaluable virgin skin has been scarred.

Figure
24 - "Team Approach" to bilateral
microtia.

24a

24b

24c

24a) Construction of auricle by
author. (24b) Otologic surgeon now proceeds: Constructed auricle
is lifted from bed, bony canal is drilled, and the middle ear repair
is completed. Next, intervening soft tissues will be removed to exteriorize
the canal. (24c) The completed repair achieved by this "team approach" of
plastic surgeon and otologic surgeon.

Staging and Timing in Bilateral (Both-ear) Microtia

Patients with both ears involved are staged so as to minimize the number
of operations. In bilateral microtia, I cartilage graft each side as separate
operations, because each side of the chest contains sufficient cartilage
for only one good ear framework. Simultaneous bilateral reconstruction
would necessitate bilateral chest wounds with attendant discomfort and
respiratory distress. Furthermore, the first auricular repair might be
jeopardized upon turning the head to do the second side. For these reasons,
I prefer to do the first stage of each ear on separate occasions.

Following the first rib graft operation, the second side can be done safely
as early as six weeks. Then, after a waiting period of two to three months,
both earlobes can be positioned during one surgery. Then three more months
are allowed to lapse. The two ears are lifted from the head with skin grafts
during separate procedures, separated by a minimum of three months. With
this timing, the two ears can be constructed in just five operations within
a reasonable time frame. If tragus constructions are to be done, they both
can be performed later on at a single surgery (see Fig. 24).

Figure 24, continued.

24d

24e

(24d) Preoperative views of the same bilateral microtia
patient. (24e) Bilateral results of the external and
middle ear "team repair."

(24g) Results of the “team repair.” Both
external ears have been constructed with rib cartilage grafts;
the right
surgically-created canal is visible. The left canal surgery is
planned in several months time.

(24h) The final result, shown 6 years postoperatively. The boy
no longer needs hearing aids, and excels at numerous contact sports
without concern.